Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, United States of America.
Department of Radiology, NYU Langone Orthopedic Hospital, 301 East 17th Street, Rm 600, New York, NY 10003, United States of America.
Clin Imaging. 2021 Feb;70:74-80. doi: 10.1016/j.clinimag.2020.10.026. Epub 2020 Oct 22.
To assess MRI appearance of the dermal allograft and its correlation with clinical outcome following superior capsular reconstruction (SCR).
This is a retrospective study of patients who underwent SCR between 2015 and 2018. Patients with postoperative MRI and clinical follow-up were included. Exclusion criteria were preoperative shoulder instability, advanced glenohumeral arthritis, and lack of postoperative MRI or clinical follow-up. Radiographs and MRIs were evaluated for graft integrity and position, acromiohumeral interval, superior subluxation distance (SSD), and glenohumeral cartilage loss. Correlation between imaging and clinical outcome measures were assessed.
24 shoulders (23 patients) met the inclusion criteria at a mean clinical and MRI follow-up of 9.1 months. There were 12 intact grafts (50%) and 12 torn grafts (50%), most commonly at the glenoid attachment (8/12). Patients with graft tear had greater SSD (mean 10.5 ± 6.1 mm) than those without tear (mean 6.1 ± 3.8 mm) (p = 0.028). SSD > 7.9 mm had a 79% sensitivity and 91% specificity for graft tear. The intact grafts were more commonly covering the superior humeral head (91.7%) compared with the torn grafts (41.7%) (p = 0.027). There was improvement of clinical outcome measures including American Shoulder and Elbow Surgeons score (p = 0.005) and forward elevation (p = 0.021) although there was no correlation between clinical outcome and integrity of the graft.
SCR results in significant short-term clinical improvement even in the presence of graft tear on postoperative MRIs on current study. Gap between graft and the anchors, non-superior position of the graft, and humeral head superior subluxation can be associated with tear.
评估真皮移植物的 MRI 表现及其与肩袖上囊重建（SCR）后临床结果的相关性。
这是一项回顾性研究，纳入了 2015 年至 2018 年间接受 SCR 的患者。纳入标准为术后有 MRI 和临床随访的患者。排除标准为术前有肩关节不稳定、晚期肩关节炎以及缺乏术后 MRI 或临床随访的患者。评估了 X 线片和 MRI 以确定移植物的完整性和位置、肩峰肱骨头间距（acromiohumeral interval，AHAI）、肱骨头向上移位距离（superior subluxation distance，SSD）和肱骨头关节软骨的损失。评估了影像学与临床结果测量之间的相关性。
24 个肩关节（23 例患者）符合纳入标准，平均临床和 MRI 随访时间为 9.1 个月。12 个移植物完整（50%），12 个移植物撕裂（50%），最常见于关节盂附着处（8/12）。移植物撕裂的患者 SSD 较大（平均 10.5±6.1mm），而未撕裂的患者 SSD 较小（平均 6.1±3.8mm）（p=0.028）。SSD＞7.9mm 对移植物撕裂的敏感性为 79%，特异性为 91%。完整的移植物更常见于覆盖肱骨头的上方（91.7%），而撕裂的移植物则较少（41.7%）（p=0.027）。尽管移植物完整性与临床结果之间无相关性，但临床结果测量指标（包括美国肩肘外科医师评分（American Shoulder and Elbow Surgeons score，ASES）和前向活动度（forward elevation））均有改善（p=0.005 和 p=0.021）。
在本研究中，即使术后 MRI 显示移植物撕裂，SCR 也能显著改善短期临床结果。移植物与锚钉之间的间隙、移植物的非上位、肱骨头向上移位与撕裂可能相关。
